A Refreshed Framework for Maternity Care in Scotland: The Maternity Services Action Group

EXECUTIVE SUMMARY

This document is intended as a refreshment of the national Framework for Maternity Services in Scotland, first published in 2001. It has been developed by a writing group of the Maternity Services Action Group ( MSAG). MSAG is convened by the Scottish Government and is the strategic group for maternity services in Scotland. It brings the Scottish Government together with key stakeholders from maternity services, the Royal Colleges, Special Health Boards and the Scottish Health Council. A full list of organisations represented is available in Appendix 1.

The refreshed framework is designed to address all care from conception, throughout pregnancy and during the postnatal phase. The term maternity care within this document is intended to refer to anyNHS service providing maternity care to women and their babies- including care provided by Midwives, Obstetricians, General Practitioners, Anaesthetists, Paediatricians, Neonatologists, Public Health Nurses, Pharmacists, Optometrists, Dentists and Allied Health Professionals. Effective collaboration and communication between all of these disciplines and services, and particularly between primary care, public health nursing and maternity services, is essential for person centred, safe and effective maternity care. Specific standards of care for babies in need of additional, special care are being developed for neonatal services by a national Neonatal Expert Advisory Group.

Whilst this framework is concerned with maternity care, the principles and some of the service descriptors will be of relevance to other staff providing NHS services to women and their babies, including sexual health and reproductive health staff, substance misuse and addictions staff, mental health staff and community pharmacy staff. In addition to those providing direct maternity care, the framework is intended for use by NHS Board and regional planners; clinical governance and performance management staff. Additionally, it is intended as a reference source for local authority and Third Sector services ¹.

This framework has the following sections:

• Introduction
• Policy context
• Policy and Evidence into practice
• Summary of key quality indicators and health outcomes
• Overarching principles for all aspects of the woman and baby's journey through maternity care
• Service descriptors for each part of the journey through maternity care- antenatal care, labour and birth and postnatal care
• Glossary
• Appendix

KEY DRIVERS FOR REFRESHING THE FRAMEWORK ARE:

• The need to reduce inequalities in maternal and infant health outcomes at birth and across the life course.
• The need to measure improved access, care and experience for all women, prioritising improvements for those at risk of poor health outcomes.
• The need to develop tailored, proportionate, universal provision that identifies and facilitates access to specialist provision where needed.
• The need to strengthen communication and collaboration between services providing maternity care.
• The need to use women's experience of care to drive service improvement.
• The importance of strengthening NHS Board planning of maternity care at regional level; within local Children and Adult service planning processes and within local Community Planning Partnerships.
• The fundamental and critical importance of workforce planning and development to ensure that all women and their babies are cared for by the right team of people, with the right skills, in the right place, every time.

IMPLEMENTATION

The framework is ambitious and demanding. It recognises the need to strengthen the contribution of maternity care to giving all children the best start in life through protecting and promoting the health and wellbeing of the mother and family.

It is recognised that there will be a number of challenges in translating this refreshed framework into practice. These implementation challenges range from- constrained public service resources in the short to medium term, workforce planning and development needs, to information and data issues. These are substantial challenges, but they must not hamper consistent service improvement over time. Indeed the challenges are in themselves imperatives for improvement. The evidence is strong that investing in early intervention, prevention and support as early as possible leads to significant savings across public services.

'A wide range of economic studies suggest that returns to early investment in children during the pre-birth period and first few months of life, up to the age of eight years old are high, but reduce the later the investment is initiated. Investment in early and effective interventions translates into substantial savings to the public sector.' Tackling Child Poverty in Scotland- A Discussion Paper. ²

For maternity care services reaching and managing higher risk groups of women in the antenatal period will help strengthen NHS capacity to both promote healthier pregnancies and effectively manage the co morbidities which often lead to premature births and poorer maternal and infant health outcomes- thereby reducing demand on neonatal and paediatric services in the short term to medium term. ³

The future financial constraints, rather than being a barrier to action, provide an imperative to implement this framework.

Achieving improvements in access to maternity care and equity in the quality of the care received will require the harnessing of resources at national, regional and individual NHS Board levels. Key expertise and inputs will need to be drawn from national bodies and from NHS Board expertise across Public Health, Learning and Development, Organisational Development and Planning and Performance Management. Individual NHS Board's will require flexibility and time to respond effectively to the more challenging aspects of the frameworks implementation depending on their local population profiles and needs.

The development of outcomes focused implementation plan with realistic timescales by the end of March 2012 will be essential to ensuring translation of this framework into practice. NHS Boards will need to play a central role in the development of an implementation plan alongside other key stakeholders. Principle 1 of the framework calls for a named Executive Director from each NHS Board to provide leadership, governance and momentum to its implementation.